Government. What would you do with the portions of this bill which would create additional fellowships and scholarships and additional activities in the field of basic research as distinguished from applied research?

Dr. SCHEELE. I don't think that the two are incompatible. I think if the Science Foundation is passed, it will merely carry out to fuller blossom the needs of the country in terms of fellowship support. We are so very far away from doing what we should do with the appropriations which have been made available to date. The range of medicine again is very wide, and I would feel that that bridge would be one that we would cross later. It would have to be decided by the Science Foundation, whatever the governing body was, as to just what program it wanted to operate directly. It is conceivable that the Science Foundation might want to operate in the medical field by utilizing a going fellowship program.

They might use as an agent, so to speak, existing Government agencies which have programs going for a long time. There is a provision in the Science Foundation bills for the use of existing Government agencies to carry out a part of the program. The Science Foundation is keyed to basic research and the program that we now have in the Public Health Service is keyed not only to basic research but it is keyed to the whole range of research and it is keyed to clinical research as well which I might even call something intermediate between basic and applied.

Mr. HESELTON. If I understand the situation correctly and my only reason for bringing it out is to get my thinking clear in terms of your interpretation of the features of the National Science Foundation Act, would you say that it would be harmful to the objectives of this legislation to confine it to applied research as contrasted to basic research, on the assumption that would you have the same results accomplished in the National Science Foundation Act?

Dr. SCHEELE. Of course, my answer to that may seem a bit queer. As a doctor and as Surgeon General, I am concerned with the health of the people, and we are of course most anxious to have something done about that problem. Research is vital. Training of more research people is vital, and we would like to see any legislation in the health field which comes up be broad.

If we put the limitation in and then the Science Foundation did not come along, we would have omitted something very vital. It seems to me it can be reconciled later on because the Science Foundation will have the major authority in Government in this research field.

Mr. HESELTON. My question is based on the assumption that there would be Science Foundation legislation. If there is, would it be harmful or would it not be helpful to draw the line between what is to be done under the terms of that legislation and what would be done under the terms of this legislation?

Dr. SCHEELE. I don't think that to me represents very much of a problem. You would still have this duplication with authority now in Public Law 410. If the heart bill, as suggested, is finally recast in the form of an amendment to Public Law 410, there will not be any special provision for research fellowships in the heart field, because that authorization already exists in Public Law 410. To amend Public Law 410 to say that the Public Health Service may give re

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search fellowships in all medical fields, but that in heart it would be limited only to applied research, would seem to me to be drawing the point very fine and it might defeat part of the basic purpose.

Mr. HESELTON. I did not mention this particular provision of the draft of the Science Foundation Act but of course you are aware of the fact that the Foundation is directed and authorized under section 4 to establish for a period of time as it may determine a special commission on heart and cardiovascular diseases. That seems to me to point up the fact even more that you may well be running into duplication whether it is heart disease or cancer or any other field of medical research.

There still remains the reason for such bill, the obvious unrelated and scattered types of activity throughout the Federal Government which no one is able to put their finger on. I might say this, in that connection, that I asked the Library of Congress 2 years ago, at the request of a constituent, to try to find out if they could for me the total amount in dollars in the President's Budget for research. They threw their hands up and said it was utterly impossible for anyone to do it. That was after they consulted with the departments.

They said that they could not tell what we were spending for research. I don't mean to place dollars and cents on the same level as lives or health, but I do think that we have to have in mind as responsible legislators that very question of a mushroom growth, which may in itself defeat the purposes of the legislation.

Dr. SCHEELE. Again on that score, I don't think that we would be creating duplication in creating a Heart Council as these bills propose in terms of the heart commission which might be established under the Heart Foundation. In all of our discussions with the people who have been supportng the foundation bill, it has been brought out that those commissions were visualized as more or less ad hoc commissions which would survey the field but would not continue as an operating entity.

It would seem very logical that if a Science Foundation were created before a national heart institute were created, the commission on heart if it were set up might welcome a recommendation that a national heart institute be set up, and that there be a heart council to advise the Public Health Service on its program. As you will recall all along, other witnesses and I have brought out the fact that there are many facets in this heart program proposed here which go beyond the purely research activities.

I do not believe that the two bills are incompatible, and to me, as far as heart goes, the important thing is to hit that problem and hit it fast, because if we wait a year, 600,000 people die. Now to be sure within a year we would not be in a position to save the 600,000 lives, but we would be a year ahead in our beginning to save them in a subsequent year, or at least a portion of them.

Mr. PRIEST. I just wanted to point out that in the Science Foundation bill that was approved by the committee last year, and in the draft of Mr. Wolverton's bill for this year, there is a paragraph on page 18 of the bill which reads as follows:

The activities of the foundation shall be construed as supplementing and not superseding, curtailing, or limiting any of the functions or activities of other Government agencies authorized to engage in scientific research or development.

Mr. HESELTON. Could I make a comment on that? I thoroughly agree with you that that would be the point if this activity be authorized, but I don't think it would apply until this became law.

Mr. PRIEST. Of course not; I was just assuming that it might become law. That is all, Mr. Chairman.

The CHAIRMAN. Any further questions?

If not, Doctor, we wish to express our appreciation to you for your appearance and your background of experience as director of the National Cancer Institute and also as a director of the American Cancer Society. That certainly equips you to give the committee the benefit of the views that will be very helpful to us in the formulation of the legislation that you want.

I would like to state that we have an American Heart Association panel, composed of Dr. Charles A. R. Connor, medical director, American Heart Association, New York City; and Dr. T. Duckett Jones, Helen Hay Whitney Foundation, New York City; and Dr. David D. Rutstein, Harvard Medical School, Boston; and Dr. Tinsley Harrison, Southwestern Medical College, Dallas, Tex.

Is it the pleasure of you gentlemen to conduct a forum before us as we are so used to having over the radio in the way of a panel discussion or will you each speak individually and if so I will be glad to proceed. I notice on your program that we have a panel of ladies, probably there is as much interest in that as there is in the panel of technicians. We do not want to keep the ladies here so long that they would become discouraged and leave. We have not often the distinction of having a panel of ladies here and we certainly want to give them every encouragement to come again.

How will you proceed?

Dr. CONNOR. I am Dr. Connor of the American Heart Association. It was our plan to divide our testimony into four different parts and with your permission to have Dr. Harrison start and tell you about the general problem.

The CHAIRMAN. We will call on Dr. Tinsley Harrison, Southwestern Medical College, of Dallas, Tex.

STATEMENT OF DR. TINSLEY HARRISON, REPRESENTING THE AMERICAN HEART ASSOCIATION, SOUTHWESTERN MEDICAL COLLEGE, DALLAS, TEX.

Dr. HARRISON. The American Heart Association was founded in 1924

for the study of and the dissemination and application of knowledge concerning the causes, treatment and prevention of heart disease; the gathering of information on heart disease; the development and application of measures that would prevent heart disease; seeking and provision of occupations suitable for heart disease patients; the promotion of the establishment of special dispensary classes for heart disease patients; the extension of opportunities for adequate care for such cardiac convalescents; the promotion of permanent institutional care for such cardiac patients as are hopelessly incapacitated from self-support and the encouragement and establishment of local associations with similar objects throughout the United States.

Originally formed as a professional organization concerned primarily with the publication of scientific data for postgraduate education of physicians and the establishment of standards, the American

Heart Association has broadened its objectives to meet the urgent need for national action in solving the medical, social, and economic problems of heart disease. You are undoubtedly familiar with the public educational activities carried forward by the American Heart Association during 1947 and 1948. During these years the American Heart Association has enlisted public support for its program of research, education, and community service. The American Heart Association, composed of 5,300 members, both physicians and prominent laymen, is the only national voluntary agency exclusively devoted to the over-all problems of cardiovascular disease.

The American council on rheumatic fever is a council within the American Heart Association. It is particularly concerned with carrying on the objectives of the American Heart Association as they relate to rheumatic fever and rheumatic heart disease. The section on peripheral circulation is also an integral part of the American Heart Association. Its purpose is to facilitate study and education regarding the peripheral circulation. The scientific council of the American Heart Association was created to maintain the interest in the scientific aspects of cardiovascular disease on a high professional level. It is this particular council that would be interested in cooperating with the National Heart Council proposed by these bills H. R. 3762, 5087 and 5159.

Affiliated with the American Heart Association are local heart associations distributed through various sections of the United States. The present 22 associations include: New York, Chicago, Philadelphia, Washington, Los Angeles, California, and Miami Heart Associations; also the Illinois, Minnesota, Texas, and New England Heart Associations. These associations are engaged in scientific programs dealing with heart problems, in furthering community programs for the care, treatment, and prevention of cardiovascular disease, and in healtheducation activities conducted with the lay public, local agencies, and physicians. At present more than 40 other areas in the United States have indicated interest in forming local affiliates of the American Heart Association-applications have been received from Cleveland, Hartford, St. Louis, central Ohio, Iowa, Missouri, New Jersey, and Oregon, among other areas. These have been named merely to indicate interest on a city, regional, and State basis.

To appreciate the gravity of the task confronting the association today, one has only to study the following few facts and statistics on heart disease. The purpose of the American Heart Association in presenting these facts and statistics is to present an over-all concept of the problem, and a ready appreciation of the need for a national front against the increasing menace of heart disease.

Measured merely in terms of the number of people affected, heart disease is our Nation's most important medical and public health problem. According to the National Health Survey, estimate prevalence in 1937, 3,700,000 persons in the United States were estimated to have heart disease. Another 3,700,000 had arteriosclerosis and high blood pressure.

These two conditions accounted for more cases of chronic disease than any other cause. The next cause of chronic illness was rheumatism with 6,850,000 cases. Diseases of the heart and blood vessels which afflict 1 out of every 20 people in the Nation can certainly be called a national health problem.

Diseases of the cardiovascular system stand first in the list of causes of death in the United States. Deaths from diseases of the heart and blood vessels in 1946 numbered over 588,000.

The five next highest causes of deaths were cancer, 171,000; accidents, 95,000; nephritis, 92,000; pneumonia, 64,000; and tuberculosis, 55,000.

Heart disease accounted for more deaths than these five causes combined.

In every age group over 35 years, heart disease is the leading cause of death. Between the ages of 5 and 19 years, it is second only to accidents, and for the 20- to 35-year age group it is the third leading

cause.

The estimated number of days lost from work or other useful pursuits due to diseases of the heart and blood vessels was 152,100,000 days. The next highest cause of time lost was nervous and mental diseases which accounted for 132,500,000 lost days.

The estimated number of invalids disabled by diseases of the heart, arteriosclerosis and high blood pressure was 204,100. This group of causes of invalidism was exceeded only by nervous and mental diseases with 269,000 cases.

Ten percent of the men rejected by the United States Selective Service were disqualified because of cardiovascular disease-diseases of the heart and blood vessels.

In a survey of a special sampling of 5,000 men rejected for cardiovascular diseases in five major cities-New York, Chicago, Boston, Philadelphia, San Francisco-50 percent had been disqualified because of rheumatic heart disease. The second greatest cause of rejection due to cardiovascular diseases was hypertension, high blood pressure, which accounted for 25.6 percent of the disqualifications.

The foregoing statistics indicate the vastness of scope of this tremendous problem. It would seem that such a problem would have received tremendous governmental and public support, for research as well as educational and community services prior to this time. It is unfortunate that such support has been lacking and it is my earnest belief that the absence of such support has been responsible to a considerable degree for the difficulties encountered by scientists in meeting the continuous array of problems posed by diseases of the heart and circulation.

These bills establishing a National Heart Institute have my fullest endorsement and I know that I speak for a great many cardiovascular specialists when I urge their speedy adoption. Legislation of this nature will mark a significant achievement in the national fight now being carried on against the greatest cause of death in our Nation— diseases of the heart and circulation.

Now, in conclusion, we have made some progress, a good bit of progress in the past 20 years, but progress has been very slow. We know the causes of heart diseases pretty well. Our difficulty is that we do not know the causes of the causes. We do not know yet exactly what causes rheumatic fever. We have some ideas, but they are not clear yet.

Something has been learned about the causes of high blood pressure, but the fundamental detailed knowledge of exactly how certain disorders produce high blood pressure is still to be learned.